Targeting 'diabetes distress,' depression with more screenings

Barbara Anderson is a behavioral and clinical psychologist at Baylor College of Medicine and Texas Children s Hospital.

When Kathy Stewart learned that her 14-month-old grandson would need his blood-sugar level checked 10 times a day, she felt overwhelmed. He wasn't overweight. He wasn't lazy. She didn't understand how he could be diabetic.

"Your first concern is, will I be able to keep this child alive? Will he be able to play sports, go to birthday parties, or just be a normal kid?" Stewart said of her grandson's Type 1 diabetes. "The short answer is, yes, but when you don't have anyone telling you that and you don't know anything about this disease, it's a very frightening experience for families to go through."

Type 1 diabetes develops when the immune system destroys the cells that release insulin; Type 2 diabetes results when the body is incapable of using insulin the correct way.

Stewart, now an outreach volunteer with JDRF (formerly the Juvenile Diabetes Research Foundation), said that the demands of the diagnosis and the micromanaged lifestyle her grandson required seemed impossible in the beginning, even with the family's strong support network.

Now, many doctors believe the worldwide increase in diabetes diagnoses and the correlation between diabetes and mental-health conditions, such as depression, anxiety and eating disorders, requires more mental-health screening and treatment.

A new term, "diabetes distress," is even being used for people overwhelmed by the tasks associated with the disease. According to Anderson's viewpoint, diabetes distress occurs because most diabetes diagnoses require behavioral tasks by the person and family, "24 hours a day, without vacation days."

Some 29.1 million Americans, or 9.3 percent of the population, have diabetes, but only one-third of people with diabetes also get help for mental-health issues, according to the American Diabetes Association.

"I really believe if I walked down the sidewalk by my office, people could tell me more about the Ebola virus than they could about diabetes, which is actually kind of a paradox, when you think about it in terms of what is really impacting our country," Anderson said.

Anderson says the stigma of both diabetes and mental health has allowed the health care system to ignore the connection between the two. Since diabetics face an entire lifestyle change, the disruption to eating habits and the burden on the patient and family members can be taxing, she said.

"The challenge for the person living with diabetes is to take control of it and not let it take control of them," Anderson said. "But it's so hard to control your diabetes because it's a 24/7 job. There's no day off; there's no weekend. For families living with this, it's a great deal of stress."

Barriers, like time constraints and the complexity of the evolving health care system, have hindered the use of mental-health screenings, Anderson said.

"If we could keep diabetes patients out of the hospitals, which we could if we had routine screenings as part of diabetes care, that would be an enormous savings to the health care system," she said. "There's enough research to tell us now that if we could detect this on a regular basis we could prevent people from getting derailed from taking care of their diabetes."